Provider Demographics
NPI:1598380628
Name:ROSSANO, SALVATORE
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:ROSSANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2335 E TREASURE MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1749
Mailing Address - Country:US
Mailing Address - Phone:801-631-8452
Mailing Address - Fax:
Practice Address - Street 1:2335 E TREASURE MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-1749
Practice Address - Country:US
Practice Address - Phone:801-631-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program